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Multicenter Study
. 2018 Oct;24(10):1102.e7-1102.e15.
doi: 10.1016/j.cmi.2018.01.019. Epub 2018 Mar 3.

A pragmatic approach for mortality prediction after surgery in infective endocarditis: optimizing and refining EuroSCORE

N Fernández-Hidalgo  1 , I Ferreria-González  2 , J R Marsal  3 , A Ribera  4 , M L Aznar  5 , A de Alarcón  6 , E García-Cabrera  7 , J Gálvez-Acebal  8 , G Sánchez-Espín  9 , J M Reguera-Iglesias  10 , J De La Torre-Lima  11 , J M Lomas  12 , C Hidalgo-Tenorio  13 , N Vallejo  14 , B Miranda  15 , A Santos-Ortega  15 , M A Castro  16 , P Tornos  15 , D García-Dorado  15 , B Almirante  1
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Free article
Multicenter Study

A pragmatic approach for mortality prediction after surgery in infective endocarditis: optimizing and refining EuroSCORE

N Fernández-Hidalgo et al. Clin Microbiol Infect. 2018 Oct.
Free article

Abstract

Objective: To simplify and optimize the ability of EuroSCORE I and II to predict early mortality after surgery for infective endocarditis (IE).

Methods: Multicentre retrospective study (n = 775). Simplified scores, eliminating irrelevant variables, and new specific scores, adding specific IE variables, were created. The performance of the original, recalibrated and specific EuroSCOREs was assessed by Brier score, C-statistic and calibration plot in bootstrap samples. The Net Reclassification Index was quantified.

Results: Recalibrated scores including age, previous cardiac surgery, critical preoperative state, New York Heart Association >I, and emergent surgery (EuroSCORE I and II); renal failure and pulmonary hypertension (EuroSCORE I); and urgent surgery (EuroSCORE II) performed better than the original EuroSCOREs (Brier original and recalibrated: EuroSCORE I: 0.1770 and 0.1667; EuroSCORE II: 0.2307 and 0.1680). Performance improved with the addition of fistula, staphylococci and mitral location (EuroSCORE I and II) (Brier specific: EuroSCORE I 0.1587, EuroSCORE II 0.1592). Discrimination improved in specific models (C-statistic original, recalibrated and specific: EuroSCORE I: 0.7340, 0.7471 and 0.7728; EuroSCORE II: 0.7442, 0.7423 and 0.7700). Calibration improved in both EuroSCORE I models (intercept 0.295, slope 0.829 (original); intercept -0.094, slope 0.888 (recalibrated); intercept -0.059, slope 0.925 (specific)) but only in specific EuroSCORE II model (intercept 2.554, slope 1.114 (original); intercept -0.260, slope 0.703 (recalibrated); intercept -0.053, slope 0.930 (specific)). Net Reclassification Index was 5.1% and 20.3% for the specific EuroSCORE I and II.

Conclusions: The use of simplified EuroSCORE I and EuroSCORE II models in IE with the addition of specific variables may lead to simpler and more accurate models.

Keywords: EuroSCORE; Infective endocarditis; Mortality; Prognosis; Surgery.

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